Incidence, Presentation, and Treatment of Pediatric and Adolescent Meniscal Root Injuries

Abstract

Background:Despite the increasing incidence of sports-related knee injuries in youth athletes, few studies have reported on the diagnosis and treatment of pediatric and adolescent meniscal root injuries.Purpose:To describe traumatic posterior meniscal root injuries in a pediatric and adolescent population and compare the presentation of meniscal root injuries versus that of nonroot injuries.Study Design:Cohort study; Level of evidence, 3.Methods:A study was conducted of all knee arthroscopies performed on consecutive patients treated in a pediatric sports practice from March 2012 through February 2015. All patients who were younger than 20 years at the time of their injury and who underwent an arthroscopy with meniscal injury were included. Patients with discoid lateral meniscus, atraumatic meniscal cysts, partial-thickness meniscal root injuries (LaPrade type 1), and recurrent root tears were excluded. A comparative analysis of root and nonroot injuries was performed.Results:A total of 314 patients had surgery for meniscal injury (mean patient age, 16.0 years; range, 10.5-19.6 years). Of these patients, 58 (18.5%) posterior meniscal root injuries were identified. The root injuries were more likely to have joint line tenderness on preliminary physical examination compared with nonroot injuries (96.5% vs 58.6%, respectively; P < .001). Root injuries rarely occurred in isolation compared with nonroot meniscal tears (6.9% vs 17.6%; P = .021) and were frequently treated in combination with anterior cruciate ligament (ACL) injuries (86.2%). Lateral root injuries occurred more often in conjunction with ACL injuries compared with medial root injuries (84.8% vs 22.2%; P < .001). On review of preoperative imaging, meniscal extrusion occurred more often in root injuries than in nonroot injuries (32.8% vs 3.5%; P < .0001) and was uncommonly seen in the skeletally immature patient. Extrusion was seen more often in medial than lateral root tears (66.7% vs 21.7%; P = .008). A majority of patients (57/58) underwent transosseous suture repair of the meniscal root.Conclusion:When treating a pediatric or adolescent patient for a traumatic meniscal tear, a surgeon may expect to see a posterior meniscal root injury in as many as 1 in 6 patients. When treated for an ACL, contact, or multiligament injury or meniscal extrusion, a pediatric or adolescent patient may demonstrate a meniscal root avulsion or complex meniscal tear. These data provide practitioners with an improved ability to identify and treat meniscal root injuries that otherwise lead to rapid cartilage degeneration.

Lateral Meniscal Oblique Radial Tears Are Common With ACL Injury: A Classification System Based on Arthroscopic Tear Patterns in 600 Consecutive Patients

“…We could not find any previous reports about the incidence of posterior horn LMORTs that did not include posterior root tears. In a study of 314 pediatric and adolescent patients with meniscal injury, Wilson et al 24 found that 15% of patients had lateral meniscus posterior root injuries and that lateral meniscal root injuries occurred with ACL injuries 85% of the time. Praz et al 18 found the incidence of ACL injury with concomitant lateral meniscus posterior root tear to be 6.6%, but those authors did not include incomplete radial or longitudinal tears.…”

“…It is well established that meniscal tears may greatly alter the biomechanics of the knee, leading to increased contact pressures, instability, and accelerated development of osteoarthritis. 2,7,12,13,17,24 Studies have reported the incidence of meniscal tears associated with ACL tears to range between 47% and 65%. 1,7,9,14,18,19 Unlike medial meniscal tears, which commonly occur chronically after ACL injury, lateral meniscal tears occur most commonly with acute ACL injuries.…”

Medial Meniscus Root Repair in Patients With Open Physes

“…5 However, recent studies have described the incidence of meniscal root tears in skeletally immature populations. 6,7 It has been reported that up to 1 in 6 pediatric or adolescent patients who sustain acute meniscus tears will have a meniscal root tear. 7 It is unknown whether the detrimental consequences of meniscal root tears that have been reported in adult populations are similar in pediatric populations.…”

“…6,7 It has been reported that up to 1 in 6 pediatric or adolescent patients who sustain acute meniscus tears will have a meniscal root tear. 7 It is unknown whether the detrimental consequences of meniscal root tears that have been reported in adult populations are similar in pediatric populations. However, with the high incidence of meniscal root tears that do occur in pediatric populations, it is imperative that surgeons establish satisfactory surgical techniques for repairing the meniscus root anatomically in skeletally immature patients.…”

Impact of Insurance Status on Time to Evaluation and Treatment of Meniscal Tears in Children, Adolescents, and College-Aged Patients in the United States

“…The incidence of traumatic meniscal injuries among youth is on the rise. 14,26 Despite the increasing need for orthopaedic services among children, adolescents, and college-aged athletes in the United States, significant barriers remain in accessing these services. A nationwide survey in 2006 revealed that Medicaid-insured pediatric and adolescent patients have less access to orthopaedic surgeons compared to those with commercial insurance plans.…”